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HomeMy WebLinkAbout05-5604IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNSYLVANIA 0-1 I(S it f^ COUNTY OF CUMBERLAND, CLAREMONT NURSING AND REHABILITATION CENTER, 1000 Claremont Road Carlisle, PA 17013 Plaintiff, V. No. O S - St&/ / L_ (2(UI( ' I LORRAINE GOFORTH, 6007 Mockingbird Drive Mechanicsburg, PA 17050 Defendant. CIVIL ACTION - LAW NOTICE You have been sued in court. If you wish to defend against the claims set forth in the following pages, you must take action within twenty (20) days after this complaint and notice are served, by entering a written appearance personally or by attorney and filing in writing with the court your defenses or objections to the claims set forth against you. You are warned that if you fail to do so the case may proceed without you and a judgment may be entered against you by the court without further notice for any money claimed in the complaint or for any other claim or relief requested by the plaintiff. You may lose money or property or other rights important to you. YOU SHOULD TAKE THIS PAPER TO YOUR LAWYER AT ONCE. IF YOU DO NOT HAVE A LAWYER, GO TO OR TELEPHONE THE OFFICE SET FORTH BELOW. THIS OFFICE CAN PROVIDE YOU WITH INFORMATION ABOUT HIRING A LAWYER. IF YOU CANNOT AFFORD TO HIRE A LAWYER, THIS OFFICE MAY BE ABLE TO PROVIDE YOU WITH INFORMATION ABOUT AGENCIES THAT MAY OFFER LEGAL SERVICES TO ELIGIBLE PERSONS AT A REDUCED FEE OR NO FEE. Lawyers Reference Service Cumberland County Bar Association 2 Liberty Ave. Carlisle, PA 17013 (717) 249-3166 98271 AVISO USTED HA SIDO DEMANDADO/A EN CORTE. Si usted desea defenderse de las demandas que se presentan rods adelante en las siguientes pdginas, debe tomar acci6n dentro de los pr6ximos veinte (20) dias despues de la notificaci6n de esta Demanda y Aviso radicando personalmente o por medio de un abogado una comparecencia escrita y radicando en la Corte por escrito sus defensas de, y objecciones a, las demandas presentadas aqui en contra suya. Se le advierte de que si usted falla de tomar acci6n Como se describe anteriormente, el caso puede proceder sin usted y un fallo per cualquier suma de dinero reclamada en la demanda o cualquier otra reclamaci6n o remedio solicitado per el demandante puede ser dictado en contra suya por la Corte sin mds aviso adicional. Usted puede perder dinero o propiedad a otros derechos importantes Para usted. USTED DEBE LLEVAR ESTE DOCUMENTO A SU ABOGADO INMEDIATAMENTE. SI USTED NO TIENE UN ABOGADO, LLAME O VAYA A LA SIGUIENTE OFICINA. ESTA OFICINA PUEDE PROVEERLE INFORMACION A CERCA DE COMO CONSEGUIR UN ABOGADO. SI USTED NO PUEDE PAGAR POR LOS SERVICIOS DE UN ABOGADO, ES POSIBLE QUE ESTA OFICINA LE PUEDA PROVEER INFORMACION SOBRE AGENCIAS QUE OFREZCAN SERVICIOS LEGALES SIN CARGO O BAJO COSTO A PERSONAS QUE CUALIFICAN. Lawyers Reference Service Cumberland County Bar Association 2 Liberty Ave. Carlisle, PA 17013 (717) 249-3166 98271 IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNSYLVANIA COUNTY OF CUMBERLAND, CLAREMONT NURSING AND REHABILITATION CENTER, 1000 Claremont Road Carlisle, PA 17013 Plaintiff, V. No. v S - 6 0'-/ LORRAINE GOFORTH, 6007 Mockingbird Drive Mechanicsburg, PA 17050 Defendant. CIVIL ACTION - LAW COMPLAINT AND NOW, COMES, Plaintiff, County of Cumberland, Claremont Nursing and Rehabilitation Center ("Claremont"), by and through its attorneys, Latsha Davis Yohe & McKenna, P.C., and files the within Complaint against Defendant, Lorraine Goforth, and in support thereof, avers as follows: Plaintiff, County of Cumberland, Claremont Nursing and Rehabilitation Center (hereinafter "Claremont"), is a county operated skilled nursing care facility located at 1000 Claremont Road, Carlisle, Cumberland County, Pennsylvania. 2. Plaintiff Claremont provides medically necessary nursing services to the citizens of the Commonwealth. 3. Approximately 77% of Claremont's residents receive Medical Assistance benefits, which is Claremont's primary source of patient care revenue. 98271 4. Defendant, Lorraine Goforth (hereinafter "Goforth"), is an adult individual currently residing at 6007 Mockingbird Drive, Mechanicsburg, Cumberland County, Pennsylvania. 5. Defendant Goforth is the daughter, and was the attorney-in-fact and person responsible for the financial affairs of Daniel Liddick from November 27, 2002 to June 23, 2004. A true and correct copy of Defendant Goforth's Power of Attorney is attached hereto as Exhibit "A." Daniel Liddick was admitted to Plaintiff Claremont's nursing care facility on October 16, 2003. 7. On or about October 16, 2003, Plaintiff Claremont and Daniel Liddick, by and through his attorney-in-fact Defendant Goforth, entered into an Admission Agreement ("Agreement"), whereby Plaintiff Claremont agreed to accept Daniel Liddick as a resident at Plaintiff Claremont's nursing care facility and to provide his living accommodations, dietary services, medication/ pharmacy services, and general nursing and medical care, in exchange for a promise to pay for these items and services. A true and correct copy of the Admission Agreement is attached hereto as Exhibit "B" and made a part hereof. 8. As the Responsible Party and attorney-in-fact for Daniel Liddick, Defendant Goforth agreed to perform Daniel Liddick's duties pursuant to the Agreement, namely to use his assets and/or resources to compensate Plaintiff Claremont for the nursing care and services which it provided to him and to make an application for Medical Assistance benefits on behalf of Daniel Liddick. 98271 2 9. Defendant Goforth failed to use Daniel Liddick's assets and/or resources to pay Plaintiff Claremont for the nursing care and services which he received at Plaintiff Claremont's nursing care facility. 10. Upon information and belief, instead of using Daniel Liddick's assets and/or resources to keep his account current with Plaintiff Claremont, Defendant Goforth converted and/or transferred Daniel Liddick's assets and/or resources to herself and/or others. 11. Upon information and belief, Daniel Liddick possessed assets and received monthly social security and/or pension income in the amount sufficient to pay some or all of the outstanding changes on his account. A true and correct copy of Daniel Liddick's Admission Application, which lists his assets and income, is attached hereto as Exhibit "C." 12. Defendant Goforth received Daniel Liddick's monthly pension checks until March 2004, and his social security checks until April of 2004. 13. On June 9, 2004, Defendant Goforth's Power of Attorney over Daniel Liddick's affairs was revoked, and an accounting of her administration was requested, to which no response was ever received. A true and correct copy of the letter from John Hyams, Esq., counsel for Daniel Liddick, to Lorraine Goforth communicating the revocation and requesting the accounting is attached hereto as Exhibit "D." 14. Defendant Goforth failed to make a Medical Assistance application and failed to respond to multiple requests to provide verification of Daniel Liddick's income 98271 3 and assets. True and correct copies of the various benefit rejection notices and requests for verification of assets are attached hereto as Exhibit "E." 15. The County Assistance Office requires verification of income and assets to determine whether an individual meets the financial eligibility requirements for Medical Assistance benefits. 16. If the County Assistance Office does not receive verification of income and assets, it will deny the application for benefits. 17. Claremont filed no fewer than three Medical Assistance Applications on behalf of Daniel Liddick, and in each case, received no documentation or assistance from Defendant Goforth. 18. As a result of Defendant Goforth's failure to produce verification of income, the County Assistance Office denied three applications for benefits filed on behalf of Daniel Liddick. 19. In order to finance its operations and avoid burdening the taxpayers of Cumberland County, Plaintiff Claremont relies on responsible parties and residents to perform their obligations under their admission agreements, including paying outstanding bills from resident resources and timely applying for Medical Assistance benefits. 20. As a result of Defendant Goforth's failure to pay Plaintiff Claremont for the nursing care and services that it provided to Daniel Liddick and as a result of her failure to apply for Medical Assistance on his behalf, an outstanding balance has 98271 4 accrued and become overdue in the amount of $37,157.32. A true and correct copy of the monthly invoices is attached hereto as Exhibit "F." COUNT I - BREACH OF CONTRACT 21. Paragraphs 1 through 20 above are incorporated herself by reference as if fully set forth at length. 22. Defendant Goforth, as Daniel Liddick's attorney-in-fact, entered into an Admission Agreement with Plaintiff Claremont as more fully set forth above. See Exhibit "B". 23. Plaintiff Claremont provided nursing care and services to Daniel Liddick pursuant to the aforementioned Agreement from October 16, 2003 to the present. 24. From October 16, 2003 through the present, Daniel Liddick has carried an overdue balance in his account with Plaintiff Claremont, which is currently in the amount of $37,157.32, plus interest. 25. The balance remains unpaid, despite repeated demands for payment. 26. The outstanding balance is a result of Defendant Goforth's failure to keep Daniel Liddick's account with Plaintiff Claremont current from his resources and failure to apply for Medical Assistance benefits. 27. Defendant Goforth's failure to keep Daniel Liddick's account with Plaintiff Claremont current from Daniel Liddick's resources and failure to apply for Medical Assistance benefits constitutes a breach of the Agreement. 98271 WHEREFORE, Plaintiff Claremont demands judgment in its favor and against Defendant Goforth in the amount of $37,157.32 plus interest, together with any other relief the Court may deem just and equitable. COUNT II - QUANTUM MERUIT 28. Paragraphs 1 through 27 above are incorporated herein by reference as if fully set forth at length. 29. Plaintiff Claremont has demanded payment in full from Defendant Goforth for the nursing care and services which it provided to Daniel Liddick, and has not received payment for the same. 30. To the extent Defendant Goforth received Daniel Liddick's assets and/or income and has failed to pay for the care and services rendered by Plaintiff Claremont for the same, Defendant Goforth has been unjustly enriched. 31. To the extent Claremont has relieved Defendant Goforth of the burden of caring for her father, Defendant Goforth has been unjustly enriched. 32. Plaintiff Claremont is entitled to receive payment for the reasonable value of the nursing care and services provided to Daniel Liddick. WHEREFORE, Plaintiff Claremont demands judgment in its favor and against Defendant Goforth in the amount of $37,157.32 plus interest, together with any other relief the Court may deem just and equitable. COUNT III - BREACH OF FIDUCIARY DUTY 33. Paragraphs 1 through 32 above are incorporated herein by reference as if fully set forth at length. 98271 6 34. Defendant Goforth represented herself to be Daniel Liddick's attorney-in- fact and person responsible for his financial affairs up to and until June 9, 2004. 35. Defendant Goforth acted as Daniel Liddick's attorney-in-fact and person responsible for his financial affairs in dealing with Plaintiff Claremont up to and until June 9, 2004. 36. As Daniel Liddick's attorney-in-fact and person responsible for his financial affairs, Defendant Goforth had a fiduciary duty to Daniel Liddick, to which Plaintiff Claremont is a beneficial party, to ensure that Daniel Liddick's account with Plaintiff Claremont is kept current by using Daniel Liddick's assets and/or resources to pay Plaintiff Claremont for the nursing care and services that it rendered to Daniel Liddick. 37. Defendant Goforth breached her fiduciary duties owed to Daniel Liddick, to which Plaintiff Claremont is a beneficial party, by failing to use Daniel Liddick's assets and/or resources to keep Daniel Liddick's account with Plaintiff Claremont current, and, instead, converting and/or fraudulently transferring Daniel Liddick's assets and/or resources to herself or others. 38. As a direct result of Defendant Goforth's breach of her fiduciary duties, Plaintiff Claremont, as Daniel Liddick's primary care giver, the entity responsible for his day-to-day care, and the beneficiary of the fiduciary duty owed by Defendant Goforth to her father, has incurred damages as more fully set forth above. 98271 7 WHEREFORE, Plaintiff Claremont demands judgment in its favor and against Defendant Goforth in the amount of $37,157.32 plus interest, together with any other relief the Court may deem just and equitable. COUNT IV - CONVERSION 39. Paragraphs 1 through 38 above are incorporated herein by reference as if fully set forth at length. 40. Upon information and belief, Defendant Goforth converted, misappropriated and deprived Daniel Liddick of his right in, use and/or possession of his property as more fully set forth above. 41. To the extent Defendant Goforth's conversion, misappropriation and deprivation of Daniel Liddick's right in, use and/or possession of the aforementioned property was for the purpose of hindering or delaying their transfer to Plaintiff Claremont, these actions were beyond Defendant Goforth's authority as Daniel Liddick's attorney-in-fact. 42. As a result of the foregoing unlawful actions of Defendant Goforth, Plaintiff Claremont has incurred damages as more fully set forth above. WHEREFORE, Plaintiff Claremont demands judgment in its favor and against Defendant Goforth in the amount of $37,157.32 plus interest, together with any other relief the Court may deem just and equitable. COUNT VI - FRAUDULENT TRANSFER 43. Paragraphs 1 through 42 above are incorporated herein by reference as if fully set forth at length. 98271 8 44. Upon information and belief, Defendant Goforth, in her capacity as Daniel Liddick's attorney-in-fact, transferred Daniel Liddick's assets and/or resources without receiving reasonably equivalent value and/or for the purpose of hindering and delaying their transfer to Plaintiff Claremont. 45. Upon information and belief, Defendant Goforth accepted the transfer(s) of Daniel Liddick's assets and/or resources with full knowledge that the transfer was not for reasonably equivalent value and/or that the purpose of the transfer was to avoid paying Plaintiff Claremont for the nursing care and services that it has rendered to Daniel Liddick. WHEREFORE, Plaintiff Claremont demands judgment in its favor and against Defendant Goforth in the amount of $37,157.32 plus interest, together with any other relief the Court may deem just and equitable. COUNT VI - SUPPORT OF INDIGENT PERSONS 46. Paragraphs 1 through 45 above are incorporated herein by reference as if fully set forth at length. 47. Pursuant to 23 Pa.C.S. § 4601 et seq., the children of indigent parents have an obligation to care for, maintain and /or financially assist their parents. 48. Defendant Goforth is Daniel Liddick's daughter. 49. Upon information and belief as more fully set forth above, Defendant Goforth transferred Daniel Liddick's assets to herself, or otherwise misappropriated said assets. 98271 9 50. Upon information and belief, the above-referenced transfer and/or misappropriation of assets rendered Daniel Liddick indigent and unable to pay the outstanding balance owed on his account. 51. To the extent Defendant Goforth transferred Daniel Liddick's assets to herself or otherwise misappropriated said assets, she was able to financially support her father, and had the ability to satisfy some or all of the outstanding balance owed on his account. 52. To the extent Defendant Goforth is able to but has not provided care, maintenance, and financial assistance for her father, she has violated 23 Pa.C.S. § 4603. WHEREFORE, Plaintiff Claremont demands judgment in its favor and against Defendant Goforth in the amount of $37,157.32 plus interest, together with any other relief the Court may deem just and equitable. 98271 10 Respectfully submitted, Dated: 10 • Z S • dO05? LATSHA DAVIS YOHE & McKENNA, P.C. ?l By: Kimber L. Latsha, Esq. Attorney I.D. No. 32934 Steven M. Montresor Attorney I.D. No. 74244 1700 Bent Creek Boulevard, Suite 140 Mechanicsburg, PA 17050 (717) 620-2424 Attorneys for Plaintiff, County of Cumberland, Claremont Nursing & Rehabilitation Center 98271 11 VERIFICATION I, Mary Kimmel, hereby verify that I am the Finance Manager for County of Cumberland, Claremont Nursing & Rehabilitation Center; that I am authorized to make the within Verification; and the statements of fact in the foregoing Complaint are true and correct to the best of my knowledge, information and belief. I understand that any false statements therein are subject to the penalties contained in 18 Pa. C. S. § 4904, relating to unsworn falsification to authorities. Dated: A Mary morel // l` WW !,A q NOTICE THE PURPOSE OF THIS POWER OF ATTORNEY IS TO GIVE THE PERSON YOU DESIGNATE (YOUR "AGENT") BROAD POWERS TO HANDLE YOUR PROPERTY, WHICH MAY INCLUDE POWERS TO SELL OR OTHERWISE DISPOSE OF ANY REAL OR PERSONAL PROPERTY WITHOUT ADVANCE NOTICE TO YOU OR APPROVAL BY YOU. THIS POWER OF ATTORNEY DOES NOT IMPOSE A DUTY ON YOUR AGENT TO EXERCISE GRANTED POWERS, BUT WHEN POWERS ARE EXERCISED, YOUR AGENT MUST USE DUE CARE TO ACT FOR YOUR BENEFIT AND IN ACCORDANCE WITH THIS POWER OF ATTORNEY. YOUR AGENT MAY EXERCISE THE POWERS GIVEN HERE THROUGHOUT YOUR LIFETIME, EVEN AFTER YOU BECOME INCAPACITATED, UNLESS YOU EXPRESSLY LIMIT THE DU-RATION OF THESE POWERS OR YOU REVOKE THESE POWERS OR A COURT ACTING ON YOUR BEHALF TERMINATES YOUR AGENT'S AUTHORITY. YOUR AGENT MUST KEEP YOUR FUNDS SEPARATE. FROM YOUR AGENT'S FUNDS. A COURT CAN TAKE AWAY THE POWERS OF YOUR AGENT IF IT FINDS YOUR AGENT IS NOT ACTING PROPERLY. THE POWERS AND DUTIES OF AN AGENT UNDER A POWER OF ATTORNEY ARE EXPLAINED MORE FULLY" IN 20 Pa.C.S. CH. 56. IF THERE IS ANYTHING ABOUT THIS FORM THAT YOU DO NOT UNDERSTAND, YOU SHOULD ASK A LAWYER OF YOUR OWN CHOOSNG TO EXPLAIN IT TO YOU. I HAVE READ OR HAD EXPLAINED TO ME THIS NOTICE AND I UNDERSTAND ITS CONTENTS. 0 Z ?A/-y7 Date: Principal 1 DURABLE POWER OF ATTORNEY I, DANIEL S. LIDDICK, residing at 75 Pine Hill Road, Enola, Cumberland County, Pennsylvania 17025, hereby appoint Lorraine A. Goforth, an adult individual residing at 6007 Mockingbird Dr., Mechanicsburg, Cumberland County, Pennsylvania, attorney-in-fact and agent (hereinafter called "Agent") for me and on my behalf and hereby state that this Power of Attorney shall not be affected by my subsequent disability or incapacity, said Agent being empowered: To exercise any power or take any action on my behalf, as fully and completely as I could do myself, which my Agent in my Agent's sole discretion believes to be in my best interest, including but not limited to the powers and actions hereinafter described; To engage in banking and financing transactions; To enter safe deposit boxes; To draw checks against any bank account in my name; to make deposits or withdrawals and to transfer funds from one account to another, to open and close bank accounts and to sign signature cards and any other documents required for such purposes; To pay my bills and other financial obligations and to collect moneys owed to me; To borrow money, for any purpose, including but not limited to purchase of United States Treasury securities redeemable at par for federal estate tax purposes, or to lend my money, on such terms and with such security, if any, as my Agent deems advisable, To make limited gifts; To create a trust for my benefit, To make additions to an existing trust for my benefit, To claim an elective share of the estate of my deceased spouse; To disclaim any interest in property, To withdraw and receive the income or corpus of a trust, To renounce fiduciary positions; To engage in real property transactions, including but not limited to the power to manage, lease, sell, mortgage, or transfer any real estate or interest therein belonging to me, and to purchase real estate, upon such terms and for such prices as my Agent deems advisable; 2 To sell, transfer or purchase shares of stock, bonds, securities, mortgages, motor vehicles, and tangible personal property upon such terms and for such prices as my Agent deems advisable; To engage in stock, bond and other securities transactions, and to engage in commodity and option transactions, including but not limited to the power to invest, reinvest and keep invested or uninvested without liability moneys and assets belonging to me in such stocks, bonds and other instruments of indebtedness and investment, including without limitation United States Treasury securities redeemable at par for federal estate tax purposes, as my Agent deems desirable; To engage in tangible personal property transactions; To engage in insurance transactions, To make application for registration of any motor vehicle that I own, and to purchase in my name insurance covering the ownership and operation of any motor vehicle; To vote, appoint or revoke proxies, execute any waiver of consent, attend any meeting, and otherwise to act without restriction in my behalf in connection with any stock, security, membership, proprietary, proxy, interest, or other rights that I may have in any corporation, association, partnership, business trust, joint venture, limited liability company, or other entity; To pursue claims and Litigation, including but not limited to the power to commence.. prosecute, defend, settle or compromise any claim, suit, action, or other proceeding at law or in equity as my Agent deems advisable and for these purposes to employ counsel; To handle interests in estate and trusts, including but not limited to the power to create and execute legal documents on my behalf, including without limitation the exercise of options, elections under or against wills and trusts, releases, disclaimers and renunciations of interests, property and powers, contracts, and revocable or irrevocable trusts for my benefit, and to fund such trusts with property belonging to me; To engage in retirement plan transactions; To receive government benefits; To pursue tax matters, including but not limited to the power to appear for me and to execute powers of attorney for others to appear for me before the Treasury Department of the United States and any state or municipal authorities, in all matters pertaining to federal, state or local taxes; to examine records and receive confidential information and communications with reference to such taxes; to execute and file income, gift and other tax returns and declarations of estimated tax, waivers, claims for refund, agreements of settlement or compromise, and consents extending the statutory period for assessment or collection of taxes; to make any and all elections afforded a taxpayer with respect to the filing of returns, and for these purposes to employ counsel and accountants, To exercise any rights that I have with respect to any policies of insurance on my life of which I am the owner or in which I have any rights, including but not limited to the following; the right to cancel and/or surrender the policy and to receive the cash value; the right to borrow all or part of the cash value; the right to convert the policy to a paid-up status; and the right to exercise any settlement options; To take charge of my person in case of illness or disability of any kind; to authorize my admission to a medical, nursing, residential or similar facility, and to enter into agreements for my care; to authorize, or withhold consent to, medical and surgical procedures; and to remove and place me in such institutions or places as my Agent may deem best for my personal care, comfort, benefit and safety after giving consideration to any wishes I may have expressed on this subject, and To make an anatomical gift of all or part of my body. I authorize my Agent to appoint in writing from time to time one or more persons as a substitute or substitutes in the place of my Agent and to revoke such appointments, granting to any such substitute full power and authority to act in the place of my Agent for me and on my behalf. I hereby ratify and confirm all that my Agent or proper substitutes shall do by virtue of this Power of Attorney. E WITNESS WHEREOF, I have signed my name this a7 day of 002. WITNESS: ?y n (SEAL) DANIEL S. LIDDICK COMMONWEALTH OF PENNSYLVANIA- COUNTY OF SS. On this, the obi I day of / 1 , Vf rn 6-' 2002, before me, a Notary Public, the undersigned officer, personally appeared DANIEL S. LIDDICK, known to me (or satisfactorily proven) to be the person whose name is subscribed to the within instrument, and acknowledged that he executed the same for the purposes therein contained. IN WITNESS WHEREOF, I hereunto set my hand and official seal. X-L,t /J /lC otary Public My commission expires: Notanal Seal Blanche A. Morrison No(ary Public City Of Harrisburg, Dauphin County My commission Expires Nov. 8, 2005 Member, Pennsylvania Association DI Noiaries Acknowledgment bent I, Lorraine A. Goforth, have read the attached Power of Attorney and am the person identified as the Agent for the principal. I hereby acknowledge that in the absence of a specific provision to the contrary in the Power of Attorney or in 20 Pa. C. S., when I act as Agent: I shall exercise the powers for the benefit of the principal. I shall keep the assets of the principal separate from my assets. I shall exercise reasonable caution and prudence. I shall keep a full and accurate record of all actions, receipts, and disbursements on behalf of the principal. Agent Date: &Y,,, Sworn to before me this 27' day of November, 2002. otary Public ticta"al seal Blanche ?. wcr;ison, Notary Public C?rv C't Ha nsnUig, Dauphin County Vy Ccmmission Expires Nov_ 8, 2CC5 _- -- s,v+ 7-a Aes . lion Of Nctanes Cx ?} b? GEC ?? Pehahilitcition Center ADMISSION AGREEMENT Resident Name 375 Claremont Drive Carlisle, PA 17013-8805 main (717) 243-2031 fox (717) 240-1952 As part of admission to Claremont Nursing and Rehabilitation Center, the Resident and the Responsible Party assisting the resident acknowledge and agree to the following: 1. If Claremont Nursing and Rehabilitation Center determines that the Resident is not appropriate or does not qualify for nursing home care, the Resident will discharge from Claremont Nursing and Rehabilitation Center following a 30 day notification of the need to make alternate living arrangements. 2 If the Resident cannot qualify for coverage under the Medical Assistance or Medicare programs, the Resident will pay daily rate for care at the nursing facility. 3. The Responsible Party (guarantor) assures that the Resident's bill will be paid from the Resident's assets/funds. If the Resident does not have personal funds or when personal funds are exhausted, the Responsible Party will make application to Medical Assistance on behalf of the Resident. If the Resident does not qualify for Medical Assistance funding, the Responsible Party will arrange discharge for the Resident if the bill is not paid in a timely manner. 4. The Resident authonzes Claremont Nursing and Rehabilitation Center to release information concerning their assets, real or personal, to the Cumberland County Board of Assistance. 5. If the Resident is being covered by the Medical Assistance Program, the Resident and RespL:,sible Parry recognize that all income the Resident receives during the month of admission, must be paid to the Claremont Nursing and Rehabilitation Center, regardless of the day of admission, unless waived by the Cumberland County Board of Assistance. The Resident and Responsible Party acknowledge that all future income received by the Resident, while covered under the Medical Assistance Program, must be paid to Claremont Nursing and Rehabilitation Center. Income not applied to charges for care will be placed in the Resident Guest Fund or refunded. Resident Signature or Mafk L i Witness 4eson-s`iEtIePt Sign ure Witness j 10 /(0.03 Date fCi. i` ?- G3 Date l L d 3 Date %0, /? 0-5 Date J1 sFrrrce ailcnc.y of( toobe4aitd Comity ??? ? ? ?y 19!:4:2803 ?3:56 717-246-19Ba WTI t rehabilitation Center APPLICANT RfLL Ni PERMANEN'T' ADDRI TE•EPHONE#--)1-) B . 11TH DATE NiARITAL STAAUS DID APPLICANT O NAIVE OF VETERAN 15 THE APPLICANT) FAMILY DOES APPLICANT IQamc zod f-me hS ;?bCVf I r? 3 HOSPITAL SOCIAL WORKE? 3 3 POWER-OF-ATTORNEY??E' S TYPE OF NURSING HOME 77 ON ANTICIPATED: LONG :'ERM CAKE SHORT TERM R,EIiA13 LS APPLICANT KQSPiTaL1ZED PRESENTLY°?_ ADMISSION DATE PHYS.'CIA:YN . TELEPHONE P c9 p0mire azencu of Cun2JFrian County ,?) C? Vbk IJ LUUJ lu:uu CNRC SOCIAL SERVICE J r. uG PAGE 02/03 1000 Clar"= Rwd Carlisle, PA 170134MOS main (717) 143.2031 5.(717) 140.1952 e G? . SPOUSE vAME F4 jj2n L. t?c t e, ;A L-tCi6H I TTnRY? ve S?? $RA* G+i C,k r STATES Cr. IZEN? Address Work Telephonc 0 rl -1 riiuoci?G VCI I0 Lu" luau ?H?14120H3 13:58 717-242-a K-4 APPLICNY]ON PACE I ChFC SOCIAL 53-'-RVICE ,t. PACE 03!03 LIST 0 T HER HOSPITAL AND NURSNG HOME STAYS iN T!M LAST 60 DnY&. 6 6 DOES THE APFLICAINT N. EVE AV%S7m. RY CF MEti'TAL. BEALTH':•REA-rmmNF? YIpj. EEALTH NSIAI ANCE POLICY NUhIBEPS- Mv ICAR-0 ?C] ?5?Qa7 MEDICAID AARP - ^ BLUE. CROss m tQ8 0-,)qe?a ?G BLUE SHIELD ?- ` OTHER I.ONC TERM CARE NSU-RANCE FLV ANCIAL STATUS: n. j /? ?? c? • = c SOCIAL SECL= S PENSION S zs? L J AN'NITTY WCOME 5 OTHER 5 .ASSETS: CHECKLNO ACCOUNT-SAAN-f r R SAVIVGS ACCOLTIT•BANY L\-p- Q- CEPMT FICATE OF DEPO5Tf-BA..NK C ASH ANDlOR OTHER L -VESTMENTS i.'FEINSUP-1NCE-r-C)N 'AiN'Y R£AL ESTATE-LOC TIpN r1A,YCE (S j ON DEEbr?.i ¢-1 ? 'L?.i C ?? LIST ANY A.N'D ALL ASSETS THAT HAVE SELTR < iSFtFj 7tiCLUDLNG THE DA-TES OF TR0.NSFER _ I E A -MOUNT 5_ _ *%OUIVI 5 DOES THE APPLICANT IiAVS A WILL' ??`c?t ?9 ? vN U fDC? H7 `J ? D EXECUTOR'S NAN'M EXECUTOR'S ADDRESS E_XECUTOF, STELLVHCNE 1, (a, (W) PRERREII F L HOME \ _ /i77 AddissF (- ((? - / 0 Telephone ARz ARRrr%NCF.`N75 PR8-PAID° PLEASE INCLUDE COF.;S OF APPROPRATE CARDS (SOCIAL SECURITY, MEDICAL, ETC-). PLEASS ADD ADDITIONAL SHEETS OF PAPER. TO EXPLALN LNSL'RANCB TXr-ORMATIOId. YOUR PHOTOGRAvH WML BE USED FOR IDENTIFICATION PURT05ES V THE NIEDICA.L RECORD An ELsEWATERE AS KEEDED FOR PROP&R IDE\ TIFICATION. ??.? ? ,? JORDAN D. CUNNINGHAM ROBERT E. CHERNICOFF MARC W WITZIG HENRY W. VAN ECK JOHN M. HYAMS KELLY M. KNIGHT CUNNINGHAM & CHERNICOFF, P.C. ATTORNEYS AT LAW P.O. BOX 60457 HARRISBURG, PENNSYLVANIA 17106-0457 TELEPHONE (717) 238-6570 FAX (717) 238-4809 June 23, 2004 Ms. Lorraine A. Goforth 6007 Mockingbird Drive Mechanicsburg, PA 17050 RE: Revocation of Power of Attorney ( Our File No. 506002 Dear Lorraine: HERSHEY TELEPHONE (717) 534-2833 IRS NO. 23-2274135 Street Address: 2320 N. Znd Street Harrisburg, PA 17110 Please note that this office continues to represent the interests of your father, Daniel S. Liddick, Jr. Please be aware that on June 9, 2004, your Power of Attorney over your father's affairs was revoked. A true and correct copy of the Revocation of Power of Attorney is enclosed herewith. Additionally, enclosed is your father's original Notice of Revocation of Power of Attomey. As of June 9, 2004, you no longer have the ability to act as your father's agent. Pursuant to Title 20 of the Pennsylvania Consolidated Statutes Annotated Section 5610, a full accounting of all of your father's affairs is hereby requested. The requested accounting should detail every transaction that has been entered into by you on behalf of your father. I would kindly ask that you provide my office with such accounting within thirty (30) days from the receipt of this letter. Your failure to honor this request will result in litigation being commenced against you. I look forward to your anticipated response to this correspondence. Very truly John M. JMH/mlk Enclosures cc: Daniel Liddick, Jr. Donald Liddick David Liddick Diane Myers, Clairmont Nursing Ctr. , P.C. RECEIVED JUL 0 2 2004 FISCAL DEPARTMENT CNRC l ? ? ? ? ??' yQP0 JV crsl??° GEC 2? Pebabilitation Center December 12, 2003 Mrs. Lorraine Goforth 6007 Mockingbird Drive Mechanicsburg, Pa. 17050 RE: DANIEL LIDDICK -OUR RESIDENT #4374 Dear Mrs. Goforth: 1000 Claremont Road Carlisle, PA 17013-8805 main (717) 243-2031 fax (717) 240-1952 As you are aware, Mr. Liddick was admitted to our facility on October 16, 2003. On the day of admission we requested your assistance in completing the paperwork required for Mr. Liddick's admission and application to Medical Assistance. As his Power of Attorney, we need your help to resolve this issue immediately. The following items still require your completion and signature as noted: The PA 600 Application for Medical Assistance Benefits and the PA4 Authorization for Release of Information A copy of the most recent bank statements for Mr. Liddick's checking and savings accounts A copy of the vehicle registration A copy of the deed to the burial plot or a statement from the cemetery A copy of the deed of any property owned Verification of all income, including the Plumber's Pension Verification of Health Insurance premiums Kindly complete and sign all of these items as noted and return them to Dian Myers in our Business Office before December 22, 2003. Should you have any questions, please feel free to contact Dian Myers in our Business Office at (717) 240-1929. Sincerely, h e i Mary Kimmel /y ' Business Office Manager MK/d1 jl seri ice agency of Cumberland County Tti?v.y ?k.F'? L J: c __ >o a CJ `^ R, L v 0 C3 w r Cl r 0 C3 O O r r r .D r O N ap ?:: v o ? o 0 E - Ai : U i ` p N d ? - U vb ,J SY vt ?J r J (Ij ¢ p W y ¢ wp y Z W p y 3 ¢ 4p W p?y6 ¢ZyQQ °x¢w3 Qammo H-L?QW w p Z W ? VFZ JW O Q W = W m yl-yH2 ?¢az? ?OO? ¢v?n O Ln lJ ti ?.. r- j q- J J ? L(1 ti y ucrnrtl mcnl ur rugLlG WELFARE • - CUMBERLAND COUNTY ASSISTANCE OFFICE • ; o e •• ; _ ' ' • 33 WESTMINSTER DRIVE P. 0. BOX 599 9ENEFIT ELIGIBLE Eu °aLE PENDING CARLISLE, PA 17013-0599 L F??,I AiSISTANCE After the first check which may be a speaal amount you will receive $ "t C CK _ Twice a Month ? Once a Month ? In me Mail ? At the Bank MEDICAL Cl ? You have a patient pay liability of s iSSISTANCE br the periotl beginning and ending ? Efloopt Date FOOD VOu will receive 8 for the monthfs) of then you will receive food stamps in the amount o15 STAMPS a month from to ? In the Mail ? At Me Bank URSING HOME CARE Level of care amhorizatl you are expected to pay $ . a month toward your care. ?SERVCES ? 8 ecIN1 THE FOLLOWING PERSONS ARE INCLUDED LINE NA E ASST FOOD MED. SOC LINE ASST FOOD MED SOC. N0. . CHECK STAMPS ASST. SERVICE N0 NAME . CHECK STAMPS ASST. SERVICE ^ L L? 111111111111111111111ol 1111111111111111111111111 • • • • e - • Regulation Reason Code ' '-AK?vz dl v? CLj*a& QKy, J-19 Uueti 30 z e I lL L u?? 11 cclx - ULR2 'i a • • • • • • 119191=4 • • • OFOODSTAMPS Number of Persons ASSISTANCE CHECK Number of Pace. Name GROSS MONTHLY EARNED INCOME Name GROSSMONTHLY EARNED INCOME $ $ $ $ S $ Name GROSS MONTHLY UNEARNED INCOME Name GROSS MO UNEARNED I NTHLY NCOME $ $ $ S IS $ TOTAL GROSS MONTHLY INCOME $ TOTAL GROSS MONTHLY INCOME g GROSS MONTHLY DEPENDENT CARE COSTS $ GROSS MONTHLY DEPENDENT CARE COSTS $ GROSS MEDICAL COSTS $ Telephone Water/Sewage IIIIEDiCAL ASSISTANCE Number of Persons h? Electric Garbage/Trash Name GROSS MONTHLY EARNED INCOME Gas Utility installation $ Oil Other GROSS UTILITY COSTS/UTILITY STANDARD' $ $ / RENT/MORTGAGEE $ Name GROSS MO NTHLY UNEARNED I NCOME TAXES $ INSURANCE COST ON HOME $ $ TOTAL SHELTER COST -The household may Switch between the actual utility costs and the TOTAL GROSS MONTHLY INCOME $ Standard utility allowance at the time of reapplication and one NET MONTHLY INCOME/NET SEMI-ANNUAL INCOME $ additional time durin each twelve-month i d g per o . INCOME LIMIT $ CO RECORD NUMBER C CTR DIG DIST z, (?01 1 i 11 1 1 Date Telephone Number r ?Y k Gil I-? Q- r ?7??000'? MAY 2 ? A 01q tJVD FISCAL CDEPAF NRC L j,& YA I If you do not understand our decision or have any questions, contact your worker. I LEGAL HELP IS AVAILABLE AT I `rl LEGAL SERVICES, INC. t 8IRVINE ROW JCARLISLE, PA 17013-3019 -M-243-9400 717-766-8475 CLIENT COPY PA/l 112 d-e5 NOTICE TO APPLICANT 1-NO-269.0173 717-240-2700 DEPARTMENT OF PUBLIC WELFARE CUMBERLAND COUNTY ASSISTANCE OFFICE 33 WESTMINSTER DRIVE R 0. BOX 599 BENEFIT EumeLEl s "IGtor aLE PB"bwc y.. ?G?, rn V avaav r, ASSISTANCE t? CHECK After the first check whlcn may be a special amount you will recawe 5 ( C Twice a Month C] Once a Vo tM1 1n fia Mail C] At the dank EDICAL ASSISTANCE \ You have a patent pay liability of S or !he perod beginning and ehd,hg ? Ef ec:ive Cate ^QGG C 37AMPS You'. ,If '.calve S for Ne montne) of Nan you `x111 reoe,ve taod stampl In the amount of 5 a month from to In the Mail At the Bark 'U RSING HOME CARE Level at care authorirea you are exonheo to pay S a month tawara your care. rr?? lJ oERV CES Q S.eclfvt THE FOLLOWING PERSONS ARE INCLUDED NO NAME CHECX 13TOAMPS ASSDT. SERVICE N0? NAME CHEOK 77010101D1 ASSDT. SERVIO a p? e o • o• Regulanon T I ` C4 Beason C.O. U 41 =it d 1. a o .; o• a e e Q FOOD STAMPS Number of Persons aa ?• t I a a a :? q Q ASSISTANCE CHECK Number of Person Name GROSS MONTHLY EARNED INCOME Name GROSS MONTHLY SARNEO INCOME Name { GROSS MONTHLY UNEARNEDINCOME Name GROSS MONTHLY UNEARNED INCOME TOTAL GROSS MONTHLY INCOME S TOTAL GROSS MONTHLY INCOME Is GROSS MONTHLY DEPENDENT CARE COSTS S GROSS MONTHLY DEPENDENT CARE COS-t3 Is GROSS MEDICAL COSTS S Taieohone waterrseriage Q MEDICAL ASSISTANCE Number of Persons Elecmo Garba9elTrash Name GROSS MONTHLY RARNEC INCOME Gas Utility Installation $ Oil Other GROSS UTILITY COSTS/UTILITY STAINDARD* S 'S RENT/MORTGAGE Name ROSS MONTHLv UNEARNED INCOME TAXES S INSURANCE COST ON HOME S Uf/ S ??i%%:'• TOTAL SHELTER COST 3 S / / /, „ -The household may switch between the actual utility costs and the TOTAL GROSS MONTHLY INCOME S standard utility allowance at the time of reapplication and one NET (MONTHLY INCOMEINET SEMI-ANNUAL INCOME S additional time during each twelve-month period. INCOME UNIT 3 CO RECORD NUMBER OAT CTR DIG DIS 21 ?? G?)?1 P4tl p I cv ' 0, ?l l') c I Z 7 I Date ielephona Number I LEGAL HELP IS AVAILABLE AT / 1?I /I /1 n .? LEGAL SERVICES, INC. 8 IRVINE ROW CARLISLE, PA 17013-3019 717-243-9400 717-766-8475 I{Vn???n nnl iinNe.a-r-+-.A n... .1 r- 1000 Claremont Road Carlisle, PA 17013-8805 main (717) 243.2031 tax (717) 240-1952 June 4, 2004 Ms. Lorraine Goforth 6007 Mockinebird Dr. Mechanicsburg, Pa. 17050 RE: DANIEL LIDDICK- OUR RESIDENT ACCOUNT #4374 Dear Ms. Goforth: The Claremont Nursing and Rehabilitation Center has received notification from the County Assistance office that Mr. Liddick's Medical Assistance application was denied due to non-receipt of information requested by the Assistance Office. Since Medical Assistance will not be paying for Mr. Woodson's care, we must assume his care will be paid for by private pay. It is our policy to request a Private Pay Room Deposit of S6355.00 (31 Days X $205.00/Day) which is to be held and applied to the last month of Private Pay. Also, the private pay bills from December 2003 through May 2004 in the amount of 534,135.92 are now due and owing. Please remit payment to our Business Office at the above address. Should you have any questions, please feel free to contact Denise Lehman at (717) 240- 1908. Sincerely, Mary Kimmel Finance Manager I?K"_ Y Enclosure: Medical Assistance Notice CC: Daniel Liddick MK/dl _fl sertiice agency of Cumberland County &habilitation Center NOTICE TO APPLICANT • • • • • • • • - • • BENEFIT EUGISUt EUGIaLE PENGING 1.800-289-0173 117-240.7700 DEPARTMENT OF PUBLIC WELFARE CUMBERLAND COUNTY ASSISTANCE OFFICE 33 WESTMINSTER DRIVE P. O. BOX 599 CARLISLE, PA 170130599 ASSISTANCE CHECK After the first check which may be a special amount you will receive $ [3 Twice a month n U Once a Month in the Mail At the Bank MEDICAL ASSISTANCE C] You have a patient pay liability of $ for the paned beginning and ending ? Effective Date FOOD STAMPS You will receive S for the mor ih(sl of then you will receive food stamps in the amount of $ a month from to 0 In the Mail At the Bank NURSING HOME CARE Level of care authodxed you are expected to pay $ a month toward your care. SERVIOES ? STHER pecify THE FOLLOWING PERSONS ARE INCLUDED - UNE N0. NAME ASST CHECK FOOD STAMPS ME ASST. SOC SERVICE LINE NO NAME AS CHECK F OD STAMPS MED. ASST. R C SERVIC / • • • • • • [ Reason Code ..Z. 7 7 /e7 U/.tcf?'//G^"./uv..S ?./fd"L' S1?-/'6...•.e..?3 ??DD/ ,,,///Fr?ac?oy? ?L?e s??/b ?;?,/Q•.??T'i ?`+CL T+ vn pT' d/? I?LOc+.2GS/aC./C 7?5 Sol?+/?P dr ?L. idt' ^cr ?? +7 i , pF: a fir ?SS i///n/,,[??B...e /S?L?/? ? /?s/w/i'r','? ??ii?cw9/ey.r THE FOLLOWING INTO CONSIDERA FOOD STAMPS' Numberof Petsoni TION • THE AMOUNT OF YOUR BENEFITS !; =ASSISTANCE CHECK Numberof.Perscri Name GROS MONTHLY EARNED INCOME Name GROSS MONTHLY EARNEDINCOME $ $ Name GRAS MONTHLY UNEARNED INCOME Name GROSS MO UNEARNEDI NTHLY NCOME $ $ $ $ $ $ TOTAL GROSS MONTHLY INCOME is TOTAL GROSS MONTHLY INCOME $ GROSS MONTHLY DEPENDENT CARE COSTS $ GROSS MONTHLY DEPENDENT CARE COSTS $ GROSS MEDICAL COSTS $ Telephone Water/Sewage MEDICAL ASSISTANCE Number of Persons? Electric Garbage/Trash Name GROSS MONTHLY EARNED INCOME Gas Utility Installation $ Oil Other GROSS UTILITY COSTSAITILITY STANDARD' $ $ RENTIMORTGAGE $ Name GROSS MO UNEARNED I NTHLv NCOME TAXES $ $ INSURANCE COST ON HOME $ $ / TOTAL SHELTER COST $ $ // -The household may Switch between the actual utility costs and the TOTAL GROSS MONTHLY INCOME $ standard utility allowance at the time of reapplication and one NET MONTHLY INCOME/NET SEMI-ANNUAL INCOME $ additional bina during each twelve-month period. INCOME LIMIT $ CO RECORD NUMBER CAT CTR DIG OIST 21 ? app/- - GryW Workers Signature Date Telephone Number RC LEGAL HELP IS AVAILABLE AT JA 'N 0 $ 20105 xl/ ArA4 FISCAL DE Z?IAI It you do not understand our decision or have any questions, correact your worker. TC LEGAL SERVICES, INC. 8 IRVINE ROW CARLISLE. PA 17013.3019 7-243-9400 717-766.8475 c oYtt JYLllS1 Pehabilitation Center January 12, 2005 Mr. Donald Liddick 73 Pine Hill Rd. Enola, Pa. 17025 1000. Claremont Roac Carlisle, PA 17013-8805 main (717) 243-2031 fax (717) 240-1952 RE: DANIEL LIDDICK - OUR RESIDENT ACCOUNT #4374 Dear Mr. Liddick: The ( laremont Nursing and Rehabilitation Center has received notification frc-n the County Assistance Office that Mr. Liddick's Medical Assistance application was denied due to non-receipt of information requested by the Assistance Office,. Since Medical Assistance will not be paying for Mr. Liddick's care, we must assume his care will be paid for by private pay. The private pay bills from April 2004 through December 2004 in the amount of $42,172.90 are now due and owing. Kindly remit payment in full within the next 10 days. If we have not received payment within that time, we will be forced to forward this matter to our attorneys for appropriate legal action. Should you have any questions, please feel free to contact Denise Lehman at (717) 240- 1908. Sincerely, Mary Kimm Finance Manager Enclosure: Medical Assistance Notice CC: Lorraine Goforth MK/d1 -.- ~x 4 service agency of Cumberla d Countu NOTICE TO APPLICANT 1-800-269-0173 717-240-2700 DEPARTMENT OF PUBLIC WELFARE • • • • • CUMBERLAND COUNTY ASSISTANCE OFFICE • • • - • • • 33 WESTMINSTER DRIVE P, O. BOX 599 BENEFIT ELIGIBLE NOT aErvowc ELIGIBLE CARLISLE, PA 17013-0599 ?ASSISTANCE After the first check which may be a special amount you will receive$ CHECK ? Twice a Month ? Once a Month ? In the Mail ? At the Bank ? MEDICAL ? You have a patient pay liability of $ ASSISTANCE for the period beginning and ending ? Effective Date ? FOOD You will receive $ for the month(s) of then you will receive food stamps in the amount of $ STAMPS a month from to ? In the Mail ? At the Bank NURSING HOME CARE Level of care authorized you are expected to pay $ _ a month toward your care. SOCIAL OTHER ? S eci SERVICES flLLYStiA'ING;'F1Sb ,, A'RE 1NCLifDE JT ;.':. ° s .. ,, ...L,,$?-cCv'sx X LINE NAME NO. ASS CHE T CK FOOD MED. STAMPS ASST. SOC. LINE SERVICE NO. NAME ASST. CHECK FOOD STAMPS MED. ASST. C. SERVICE ?/?J tr I J ) Ole!, Lt !4L THIS • BEEN TAKEN BECAUSE OF THE FOLLOWING .? AND REGULATION R.. / / Reason Code O a_ t LJ (a/?/e 7fJ C?. L ///n/?Ot?,r,.(Jy,, " . z',, L e 'k/ V4 6-v-.n 4 ??LOVCI PAY K1?G1L OY ?lO G /KL' _?a LE_ /?R.nt ;f .I O ?bG arei 'ilo4l l y ?- ?? 9? G4'S?, I/G G+/ THE FOLLOWING ITEMS WERE TAKEN INTO CONSIDERA TION IN DETERMINING THE AMOUNT OF YOU R BENEFITS .. ° TII? v a ne ?::> ,td'-ss n . Name GROSS MONTHLY EARNEDINCOME Name GROSS MONTHLY EARNED INCOME $ $ $ $ $ Name GROSS MONTHLY . UNEARNED INCOME Name GROSSMO UNEARNED I NTHLY NCOME $ $ $ I s $ I s ':. TOTAL GROSS MONTHLY INCOME I s TOTAL GROSS MONTHLY INCOME is GROSS MONTHLY DEPENDENT CARE COSTS I s GROSS MONTHLY DEPENDENT CARE COSTS Is ? GROSS MEDICAL COSTS $ '`*}i .s+. {_s.,e.,wan.&x.:"i`t aYnr yY y55 rv.r'=h it'::' 1 qy ' ` Telephone Water/Sewage }?]MESICVSS-- AlG?E;-. iUumbetp R?}s6? ' Electric Garbage/Trash Name GROSS MONTHLY EARNED INCOME ' Gas Utility Installation A $ Oil Other $ GROSS UTILITY COSTS7UTILITY STANDARD' $ $ RENT/MORTGAGE $ Name GROSS MONTHLY UNEARNED INCOME TAXES $ $ t. INSURANCE COST ON HOME $ $ TOTAL SHELTER COST $ $ aD ! . ma itcfi. iz,fWe?n lljef?rfil apt{fflyfS a/ti] tb: a y?r7hlfs'?ill IJdnCei''at J?F -Etna bf' 1'9a{i(/)iC2bOn aDtY ? i7he ' I ' TOTAL GROSS MONTHLY INCOME NE7 MONTHLY INCOME/NE7 SEMI-ANNUAL INCOME I $ s 'All.(/bftia(J II7BGfiIl?4)B,R,C}Ttxy2/V@-(JIONftJ jiBliiid. ' a , WCOME LIMIT .S s.v.i,i i it...`a"e..ib°n rrMz v "R ....a .':t a.. 2. e .. ... • ....`) .. .,.z ..sS .. _ . . ?..i'tT i" xmN `14."'.x. ,.. m..?. . ., . ... 5. . CO RECORD NUMB/ER CAT CTR DIG DIST 3 OS? ? Q'oZ7yd Workers Signature - - ate Telephone Number RECEIVE O%",`4 MAY -4 2005 L Z ? FISCAL DEEARTMEI LEGAL SERVICES, INC. 8 IRVINE ROW CARLISLE, PA 17013-3019 717-243-9400 717-766-8475 10/10/2005 Open A/R Summary (PA375] 4394 Daniel S Liddick Due From Description Balance EC SLOE CROSS 1,635, 08 MA MEDICAL ASSISTAN 4,441. 17 PP PRIVATE PAY 37,157. 32 RI RESIDENT INCOME -40. 00 0•c 0•c 1,313.40 + 4,961.77 + 5,876.12 + 5,022.18 + 5,030.04 + 4,919.92 + 5,112 71 + 4,921 18 + 3'7,157.32 Page 1 1000 Claremont Drive 4374 ? 6STATEMENT COVERS PERIOD Carl 1512 PA 17013 15 FED. TAX NO ICON D 3NCO 9CID 10LR0 ft . . , . (717) 243-2031 23-6 3119 111 4 113 4 3 yPA-c :'vAME 13 PATIENT ADDRESS Liddick, Daniel S v 1-:,FETE SS xi 16 MSI ADMISSION 1 ' ' 210 HR 22 STAT 23 MEDICAL RECORD NO GON '" DI C ODES .ATE 1 HP 19 T Rf ERG . ,?! ;]- ^?}.. }p ,^ pp i y 91 1112191911 M 11 121303 3 4374 C:,CLPRENCE ry, __. °: - 34 OCCURRENCE CCCLRRENGE SPAN 3] ,A'E ? Nr .... cccE >rancrt q I i 9 39 VALUE CODES ' 41 VALUE CODES CQ lE AMOUNT +* COCE WOIMi DANIEL S LIDDICK a LORRAINE GOFORTH b 6007 MOCKINGBIRD DRIVE c MECHANICSBURG PA 17050 , - _ 3 ESC'iPT!ON :A HCPCS!RATES ; 45 SE"nV DATE 4,^. SERV. UNITS A; TOTAL CHARGES 46 NON-COVERED CNAP.GES 49 0120; R & B NURSING CARE - SEi 2 5. ? 0250; FHARMACY i 1i I 164:41 1 0001 TOTAL CHARGES 31 6314;41 It7ga oo 5DI ..- 3o1a3 Q?utT.E?,,?-s. L i I , I I I I IS I I - i E', PROVIDER NO. 34 PRICP PAVMENTC 55 EST. AMOUNT DUE 56 PRIVATE FAY _-- L 1 > I I I '+ :PE03 NAVE 59 PREL!60 CEPT -SSN -HIC.-;D NO idf SROIP NFME 521NSURANCE GROUP NO ZidU_icx Daniel . =AYMENT AUTHORIUTON CODES 6+ESC 65 EMPLOYER NAME 66 EMPLOYES LOCATION 6', =F,N OIAG. CC. en .?? f >•+"",..-'-' •. m 600E ., A.. G. CCDES?E ]a CCCE 76 ACM. OIAG. CD. n EC00E 76 < < ? i-SS 79 PC 53 PHINC:PALPROCEDURE 161 OTHER PR .",DOE OCEDU DATE - e 5, .: . y 62 ATTENDING PHYS.!D 11 I ? , ,2 ri, 1 Kr NN 1 OTHER PR cCDE OCE_i,R'e , DATE "?, •, •;: ?& :m;,r?'a}.:; r OTHER R cOOE EDIJRE GAr 630THER PHYS. ID N REMARK5 OTHER PHYS. ID 12/09/2004 APPROVED OMB NO. 0900-0279 pn01 H On RPC}CI¢G Papef UlaremOnL lvurs lny I _,Xl] 2 3PATIENT COV'RO_O 1000 Claremont Dri v_ 1 4374 Car11512 PA 17013 J.EM COVERS f TAXNO 6 A 5 FED roJD- 9.CD -9CID IOL-0.7 111 (717) 243-2031 R H . ?26?039.?.?- 100f00?30`--031J- . _ . 1 12 RAPE§T:YAME zIENT AOcAEES Liddick, Daniel S ,a EIPTICATE LIST a y m^ IoN DRas aTlza MEDCAL ,e:caonr onOme aces 1213 11121919 3 TT 4-3 1 I i 7? CCCJRREYCE _ i.4ic - 9+? CtiC Pa'.,E 1._„ ^?'E OGC ?RPEhC SPaN 1 r S. ao ..:' TEA _ `litiCy .441 I ? I I I l I I I ? i ? i ' ! i lq J?? :f Vn?oP GC6ES E , 41 VALUE COOFs DANIEL S LIDDICK LORRAINE GOFORTH DJ J 6007 MOCKINGBIRD DRIVE 1 I MECHANICSBURG, PA 17050 az RFr CO ! LE'cRl-rON NON ovE. Er aw RGrs 49 ?b 12?Q? & g?I UR??"Ni; CARE-BEFf--2-?5 = 0? -3T- 6355 0-0-?- 0250 PHARMACY j Z 15094 I I 000ll TOTAL CHARGES i j 32 6505:941 1 Oq' oo 5oe Sty I j ! i I I I i I I I 0'A. E. li -v'DEP NC. ?Tr.? v 'CPr A 3 E A OLWOC 56 PRIVATE PAY CLAREMONT I I „a Ca r.4M£ _? 6, O ..HC -IC NC Lydick Dan el 3'PFA`AFNTAUTHCRIZATONCDOES i+8?[ E5 EMP,OYER NAME r -IJ-G:JA).ON PFI', DAD CD ___ __QuNupIAG. CWES a CE n a "i'1 a CE 76 ADM DIAG CC c-CODE 78 5?CPRINCIPAL PROCEDURE BI CLCC pa.= OTHER PROCEDURE COpE I OdiF P2? T 101N1) I?, u l.G' I ,G r C OTHER PR OOF ?Al Co c I DA' J i M REMARKS OTHER PHYS_ ID 86 DATE 11/11/2004 I ccnnf 3 PATIENTGJNTROLNO. 1000 Claremont Drive Carlisle PA 17013 5 FED TAR NO 6 STATEMENT COVERS PEFJOD7 7COVD. 6N-0D 3GID 10 Lq D. U (717) 243-2031 - 2PATENT NAME Liddick, Daniel S 13 PATIENTADDRESS 14 BIRTHOATE 15 SIX I6 MS „ M7 ADM) i54E 'A SRC 21 0 Hq 22 STAT 23 MEDICAL RECORD NO. x - ga r 31 2 OCCURRENCE cmfi wSE 3l OCCURRENCE mDE wTfi % caofi OCCURRENCE SPAN RICM THRpAH ffi q 39 VAWE WDEmm$ - * , 41 4ALUE DANIEL S LIDDICK LORRAINE GOFORTH 6007 MOCKINGBIRD DRIVE MECHANICSBURG, PA 17050 a y a d ? REV. CD. a DESCRIPTION 34 HCPCS;RATES 45 SERV. DATE 46 SERV. UNITS 47 TO rAL CHARGES 45 NONLOVERED CHARGES 49 025 000 PHARMACY TOTAL CHARGES 3 sou Stt- 163:15 1 6313;.15 O ;L oD 1 ? //?? .Saa?as ° 3©/ 'AVER 51 PROVIDER NO. 54 PRIORPAYMENTS 55 EST. AMOUM DUE 56 eAx • • VSUREO'S NAME 59 PRE- 60 CERT. - SSN - HIC. J D NO. I51 GROUP NAME 62 INSURANCE GROUP NO. REATMENT AUTHORIZATION CODES UESC 65 EMPLOYER NAME 66 EMPLOYER LOCATION aIK. DIAG. CO. N rbDF R _ v4 ?? 76 ADM. DIAG. CD, n E-0ODE n • 60 PRINCwk PRCCEOUPE 1 a" =E DATE wre 82 ATTENDING PHYS ID ER PgOCEDURMTE mDe wTE 63 OTHER PHYS. ID ?MARKS 1 O HERPHYS.10 Claremont Nursing & Rena 2 :1 PATIENT CONTROL NO. 1000 Claremont Drive 4374 Carlisle 'PA 17013 3 FED. TAX NQ fq?T TCOVO. BNA D. 9GI D. 10i-R D. 11 (717) 243-2031 23-6 03119 8 1 08310 0311 1 PATIENT NAME Liddick, Daniel S 13 PATIENL ADDRESS BIBTHDATE IS SIX 16 MS - 1. pAIE Iv T.pE m yp 21 0 HR 22 STAT 23 MEDICAL RECORD NO. 24 _ x m y 31 1112191 M 12130 3 4374 OCCURRENCE se wrE ..,. ... OCCURRENCE moE.. wTE .,. ?,. 96 OCCURRENCE SPAN rooE THParGH 37 AI 8 39 CWE. VALUE CODES AMOIMf . ... I -a.n 41 LODE VALUE CODES AA10if1T DANIEL S LIDDICK ?ORRAINE GOFORTH 5007 MOCKINGBIRD DRIVE 4ECHANICSBURG, PA 17050 a b t d _ aE'V.CD, >3 DESCRIPTON 40 HCPCSI RATES AS SERV.OATE 9 SERV. UNITS a TOTAL CHARGES 46 NONCOVEREDCHAPGES 49 12 )25 )00 R & B NURSING CARE - S PHARMACY TOTAL CHARGES 5. 1 3 681!27 6423;27 .F )000 5331;17 50' 0_ I YER 51 PROVIDER NO. 54 PRIOR PAYMENTS 55 EST. AMOUNT DUE 56 3IVATE PAY ULARbMUNT USED'S NAME - 59 PAEL 60 CERT.-SSN HIC.-ID NO. 61 GROUP NAME 621NSURANCE GROUP NO, ck Danle S -131 158059927 ATMENT AUTF/OPIIATION CODES MESC 65 EMPLOYER NAME 66 EMPLOYER LOCATION J. OIAG. CD. M m On §... w I ADM. DIAL, CO. T7 E CODE 78 6D PRINGPAL PROCEDURE Z • ^v ?a•-? COPE )At c06E wrE , ? 92 ATTENDING PIflS ID ?OTHEA PROCEDURE P' .. •.?"ar' .• roof w E 83 OTHER PHYS 10 ARKS OMERPHVS. ID I 05 X A f }09'09"-2004.;. :FA-1450 A PFOVED OM9 NO. OGfO- q O PVOMWNAL ICFFIFI'ME CEANKAMYCCMTNE PEYEPSEAPPLYTOMS RLI AP YADEA FMTXE .. laremont Nursing & Reha 000 Claremont Drive 2 3PATENT CONTROL NO, 4374 arlisle PA 17013 5 FED. TAX NO. 6SA COVE SPERT TMR% COV O. 6N-C D. 9CID. IO LRO. 11 717) 243-2031 23-600311 07010 07310 031 TIENT NAME iddick, Daniel S 13 PATIENTADDRESS IRTHDATE 15SEX 16MS 17 CAW ADMISSION 1P TYPE W WC 21 D HR 22 STAT 23 MEDICAL RECORD NO. s1 CONI C A 31 112191 M 12130 3 4374 OCCURRENCE DATE a . .,. ?,«« ? 34 OCCURRENCE ODE )ATE ..• .... . « .. ?.. 36 cWE OCCORRENCESPAN FROM THRIXKAV 3] A 39 WDE VALUE CODES AA1OBHf ^'? 41 tODE -VkUE GM u.aMt ANIEL S LIDDICK ORRAINE GOFORTH 007 MOCKINGBIRD DRIVE ECHANICSBURG, PA 17050 a b c d EV. CO. a3 DESCRIPTION 44 HCPCSIRATES 45 SERV. DATE 46 SERV. UNITS 47 TOTAL CHARGES 48 NONCOVEREDCHARGES 49 12 25 00 R & B NURSING CARE - SE PHARMACY TOTAL CHARGES 2 5. 3 3 6355'b 60041 6415141 36/ 50 ? 3 . r 1YER 51 PROVIDER N0. 54 PRIOR PAYMENTS 55 EST. AMOUNT DUE 56 VATS PAY CLAREMONT SURED'S NAME 59 P.REL 60 CERT -SSN -HID. -ID NO. 61 GROUP NAME 62 INSURANCE GROUP NO, iddick anie IEATMENT AUTHORIZATION CODES MESC 65 EMPLOYER NAME 66 EMPLOYER LOCATION IN. DAG. CO, CWE `j?` CODES--- 71 CODE 76 ADM. DIAG. CO. 7E-CODE M BD PRINCIPAL PROCEDURE 1 = ""Pr=41 OWE DATE CODE DALE R ATTENDING PHYS IO ? L 'LL l?l? OTHER PRO WDE CEDURE a. .....,«m. WiE mD6 WrE 63 OTHER PHIS) 'MARKS OTHER PHYS. ID M V A B6 1t . xF08/12/?004 1 HCFA-1150 APPROVED OMB NO. W38-.ttI9 OCRIORIOINAL IDpifRYTNE CEP11R1.ATNM4IX11NE RCYEM3E APYLTT9TN39AL AWAIE Y APA M !W. aremont Nursing Re ha 2 3 PATIENTOONfROLNO. 1000 Claremont Drive Carlisle PA' 17013 5 88TH EN CONFAB PERgG 7 COV (717) 243-2031_-_.,_, p. 6 NC D 9 G10, 10 4R D. 11 -17 PATIENT NAME Liddick, Daniel S 4 BIRTHDATE 15SEx 16M5 ,:d ..?. DANIEL S LIDDICK LORRAINE GOFORTH 6007 MOCKINGBIRD DRIVE MEDICAL RECORD NO. 31 MECHANICSBURG, PA 17050 d x REV. CO. 43 DESCRIPTION N HCPCSIMTES 45 SERV.DATE 46 SERV. UNITS 47 TOTALCHARGES 48 NON-COVERED CHARGES 49 1012 R & B NURSING CARE - SE 2 5. 025 PHARMACY - 1119;35 000 TOTAL CHARGES 3 726 9;3 5 / // E 1 i 2 PAYER 5T. PROVIDER NO. 54 PRIOR PAYMENTS 55 EST. AMOUNT DUE M NSURED'S NAME ldd-1c 59 PREL WCERT. - SSN - HIC. - ID NO. fit GROUP NAME 621NSURANCE GROUP NO. ante F E C TREATMENT AUTHORIZATION CODES NESC 65 EMPLOYERNAME M EMPLOYER LOCATION l E ERIN. DIAL. CD. CODES M NOE ` NONN T? A CODE' . ?.n mDE `: 4S.LT.aO a mrc 76 ADM. DIAG. CO. r ECODE 78 -- ?. ?E ._ .? ..,.._.. oAiE .,... r.,.,..?..., w>E ...?T - 82 ATTENDING PHYS. ID OTHER PROCEDURE ._..m ttVE DATE CCDE DAIS 83 OTHER PHYS ID. MMMEMP? IEMARKS OTHER nrcs% 85 PROVIDER X REPRESENTATIVE 07?12?2004 2HCPA-I4BO APPROVED OMB NO. W.iB-b119 OCWORIOINAL I CFRfFYIME CEAMCAMmsm ME REYFAEE/PPLTIOIMIdLL YL YK WAIN! APMrt HFAECE. Claremont Nursing & Reha 2 - 3 PATIENT CONTROL NO. 1000 Claremont Drive 4374 Carlisle PA 17013 4 4 5 FED TAX NO. 6STATEMENT COVERS IPERIOD '_,` ]CgyD pN-0D. 9C"I D. 10L-fl 0. 11 124 TIENT 13 PATIENT ADDRESS 14 BIRTHDATE 15 SEX 16 M5 n wre ADA9e$ w N TYPE A ,,C 21 D HR 22 STAT 23 ------------ O. CON -- 31 32 OCCURRENCE :. s a:;. 3/ ORENCE wT6 wDE - wT6 «a . 35 CCCIIRPENCE SPAN -: 31 FFKM THROUGH A x w DD6 VAWE CODES .... VALUE CODES .:. A DANIEL S LIDDICK a LORRAINE GOFORTH b ' 6007 MOCKINGBIRD DRIVE EA 17050 d 42 REV CD. 43 DESCRIPTION 4 HCPCS I RATES 45 SEW. DATE M SEW, UNITS 41 TOTAL CHARGES 48 NON-COVERED CHARGES 49 012 R & B NURSING CARE SE 205.0 3 6355;00 000 TOTAL CHARGES 3 6355 : 00 / ( / h -3 0/ - 3 PAYER 51 PROVIDER NO. 54 PRIOR PAYMENTS 55 EST. AMOUNT DUE Sfi PRIVATE PAY CLAREMONT INSURED'S NAME 59PAR 60 CERT. "SSN-HIC.-ID NO. 61 GROUP NAME 621NSURANCE GROUP NO. Liddick Daniel S 0 198059927 TREATMENT AUTHORIZATION CODES 64 ESC 65 EMPLOYER NAME W EMPLOYER LOCATION .: ._ 1 PRIN. MO. CO. CODES - " A:,, `•' n WOE • . 14 WOE ' 76 ADM. DIAG.CD n E COO' 71 'C. w PRINCIPAL PROCEDURE 185 CODE DAr6 Wap wTE .._4 rR - 62 ATTENDING PHYS.p .. OTHER PROCEd1fiE?? V17 WDE wTE _Q27772 HARM, MD KENNETH R 1 63 OTHER PM ID REMARKS OTHERPHYS. ID t 85 PROVIOSREPRESENTATIVE-_7 OA, 'tea i 2; ,x X 0 'CFA-1450 /,ppROV[n nus un roa«m.n 4 ICFAIFYiME t(RIYICAMXq W TILE REVEREEIMLYTOTp BILLAM ARE W APANTHMA . C l azemont Nu s l g & Re ha 2 3 PATIENT CONTROL NO, t 1000 Clare Ino ? rive Carlisle PA 70 3 i S STATEMENT COV 5 FED. TAX NO, n ERS PERIOD Np py 7COVD. 6N-C 0. 9C1D. III L-80.11 W 3' E NTNA E 13 PAPENI ADDRESS 4 $IRTHDATE I5 SIX 16 MS • ?T '?'Ij "-',,g 21 D HR P STAT 23 MEDICAL RECORD NO. S SI M b OCCURRENCE 50M VATS ?•- ',, .,-... 34 OCCURRENCE - CONE 174 . . ••u38 : OCCURRENCE SPAN - ' 3] DATE YIE FPOM ;. Q A ... B .: , 399 VALUE CODES It VALUEODOES s :... DANIEL S LIDDICK a LORRAINE GOEORTH b 6007 MOCKINGBIRD DRIVE D d REV. CO. 43 DESCRIPTION 44 HCPCS/RATES 45 SERV. DATE AS SERV. UNITS 47 TO7'ALCHA9GE$ Q NON-COVERED CHARGES 49 012 R &,S NURSING CARE„- SE 185.0 2 4810;00 012 R.& B-NURSING CARE;-- SE ,,-205:0 820;00 000 "TOTAL CHARGES 3 5630:4 @0 I 37 LU1 " Cs ? ? -N- -110 -CZ 30 'AYER 51 PROVIDER NO. 54 PRIOR PAYMENTS 55 EST. AMOUNT DUE 56 ?RIVATE PAY CLAREMONT • 73 VSURED'SNAME 59 P.REL 6N DEFT. - SSN - HIC. - ID NO. 61 GROUP NAME V INSURANCE GROUP NO. ,iddick Daniel S 0 198059927 REATMENTAURIORILATION CODES RE56 65 EMPLOYER NAME 9 EMPLOYER LOCATION 1 R DIAG. CO. "POPE •, m woE • • confl. M 74 moE 76 ADM. DIAG. CO. n E-CODE 76 2 280 311 71 1 185 60 PSINCIPALP80CEDURE tONE wTE WoE ?? • 'a• ••.• '. 92 ATIFtlOINGPHY$.ID C27772 HARM MD KENNETH R t OTHER PROCEWRE CNOE VATS cOrh a?iE B3 OTHEA PifYS. ID i ?MARKS OTHER PLAYS. ID ,.. k o h cr, , _ VI `'Z G °? J SHERIFF'S RETURN - REGULAR CASE NO: 2005-05604 P COMMONWEALTH OF PENNSYLVANIA: COUNTY OF CUMBERLAND CUMBERLAND COUNTY OF CLAREMONT VS GOFORTH LORRAINE WILLIAM CLINE , Sheriff or Deputy Sheriff of Cumberland County,Pennsylvania, who being duly sworn according to law, says, the within COMPLAINT & NOTICE GOFORTH LORRAINE was served upon DEFENDANT the , at 1253:00 HOURS, on the 4th day of November , 2005 at 6007 MOCKINGBIRD DRIVE MECHANICSBURG. PA 17050 LORRAINE GOFORTH by handing to a true and attested copy of COMPLAINT & NOTICE together with and at the same time directing Her attention to the contents thereof. Sheriff's Costs: Docketing 18.00 Service 11.52 Affidavit .00 Surcharge 10.00 .00 39.52 So Answers: R. Thomas Kline 11/07/2005 LATSHA DAVIS YOHE MCKENNA Sworn and Subscribed to before me this /L Hf day of lit 5 A.D. Proth tary By: ?? Deputy Sheriff IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNSYLVANIA COUNTY OF CUMBERLAND, CLAREMONT NURSING AND REHABILITATION CENTER Plaintiff, V. LORRAINE GOFORTH, Defendant No. 5604 CV 2005 CIVIL ACTION - LAW ENTRY OF APPEARANCE AND NOW, THIS 5th day of December, 2005, please enter the appearance of Derek J. Cordier, Esquire, as attorney of record for the Defendant, Lorraine Goforth in the above captioned matter. Respectfully submitted by, 319 South Front Street Harrisburg, PA 17104-1621 (717) 919-4002 0 IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY PENNSYLVANIA COUNTY OF CUMBERLAND CLAREMONT NURSING AND REHABILITATION CENTER : Docket No. 2005-5604 vs : CIVIL ACTION LORRAINE GOFORTH, : LAW Defendant ANSWER TO PLAINTIFF'S COMPLAINT AND NOW, comes the Defendant, Lorraine Goforth, by and through their counsel, Derek J. Cordier, Esquire and files this Answer to Plaintiffs (Claremont) Complaint. 1. Admitted. 2. Admitted. 3. Neither admitted nor denied as Defendant has no information as to the Medical Assistance benefits provided to Claremont. 4. Admitted. 5. Denied in that the Defendant was not a guardian, but only a power of attorney, and therefore at all times Daniel Liddick was responsible for his own affairs. The Defendant was only given the power to aid Daniel Liddick, which she did. 6. Admitted. 7. Admitted. 8. Admitted. 9. Denied in that during the time the Defendant held a power of attorney for Daniel Liddick all of his Social Security and Pension benefits went directly to Claremont as noted on Plaintiffs Exhibit "F." 10. Denied, at no time did the Defendant break her fiduciary responsibility to Daniel Liddick. 11. Admitted and denied, admitted in that Daniel Liddick received social security and pension benefits that Claremont received as noted on Plaintiffs Exhibit "F," denied in that they were sufficient to pay the outstanding charges on his account and that Plaintiffs Exhibit "C" does not list any assets of Daniel Liddick, but does list that he filed a Chapter 13 Bankruptcy. 12. Admitted. 13. Admitted and denied, admitted that an accounting was requested, however due to the power of attorney revocation, the Defendant did not open the letter and the first time she read the letter was upon service of Plaintiffs Complaint. An accounting shall be provided to Plaintiff within one month of the filing of this Answer to Plaintiffs Complaint. 14. Denied, the Defendant was never named as the Guardian of the Estate of Daniel Liddick as he was never found incompetent to manage his own affairs. The Defendant was told by Diane Myers of the Claremont business office that the application was being taken care of by her office and Daniel Liddick was fully capable of managing his own affairs, which included applying for Medical Assistance. Further, the Plaintiffs Exhibit "C" lists Daniel Liddick's income and assets. 15. Unable to admit or deny, as the Defendant is unaware of the County Assistance Office procedures. 16. Unable to admit or deny, as the Defendant is unaware of the County Assistance Office procedures. 17. Unable to admit or deny, as the Defendant cannot confirm that Claremont made three Medical Assistance Applications, however, if Claremont made the applications, the question would be what information did they use to make three separate applications? Further, the Defendant was not the Guardian of the Estate of Daniel Liddick and therefore, Daniel Liddick was capable of providing said information. 18. Defendant was not the Guardian of the Estate of Daniel Liddick and therefore, Daniel Liddick was capable of providing said information. 19. Unable to admit or deny as the Defendant has no information as to the finances of Claremont. 20. Defendant was not the Guardian of the Estate of Daniel Liddick and therefore, Daniel Liddick was capable of providing the information necessary for the application for Medical Assistance and to make sure that his bills were being paid and if the bills were not paid was capable of having moving from the facility. Further, the monthly invoices found in Plaintiffs Exhibit "F" do not cover the entire length of his stay, have handwritten deductions on them, do not break down Daniel Liddick's costs for Claremont's services and therefore do not serve as an accounting. 21. Admitted. 22. Admitted. 23. Unable to admit or deny as the Defendant is not aware of the services provided by Claremont as the Defendant no longer holds a power of attorney for Daniel Liddick. 24. Unable to admit or deny as the Defendant is not aware of the services provided by Claremont as the Defendant no longer holds a power of attorney for Daniel Liddick. 25. Unable to admit or deny as the Defendant is not aware of the services provided by Claremont as the Defendant no longer holds a power of attorney for Daniel Liddick. 26. Denied. 27. Denied, the Defendant acted as an agent for Daniel Liddick and at no time was she made aware that she may be personally responsible for costs of Daniel Liddick's care. The Defendant was removed as power of attorney and although she held a power of attorney she was not a guardian over Daniel Liddick's person or estate and can not be held responsible for having him removed from Claremont or payment of his expenses. 28. Admitted. 29. Denied, the Defendant is not a power of attorney for Daniel Liddick nor is she his guardian. 30. Denied, at no time did the Defendant break her fiduciary responsibility to the Daniel Liddick. 31. Denied, at no time did the Defendant break her fiduciary responsibility to the Daniel Liddick. 32. Unable to admit or deny as the Defendant has no information as to the value of Claremont's services. 33. Admitted. 34. Denied in that the Defendant was not a guardian, but only a power of attorney, and therefore at all times Daniel Liddick was responsible for his own affairs. The Defendant was only given the power to aid Daniel Liddick, which she did. 35. Denied in that the Defendant was not a guardian, but only a power of attorney, and therefore at all times Daniel Liddick was responsible for his own affairs. The Defendant was only given the power to aid Daniel Liddick, which she did. 36. Denied in that the Defendant was not a guardian, but only a power of attorney, and therefore at all times Daniel Liddick was responsible for his own affairs. The Defendant was only given the power to aid Daniel Liddick, which she did.. 37. Denied, the Defendant never broke her fiduciary duty to Daniel Liddick. 38. Denied in that the Defendant was not a guardian, but only a power of attorney, and therefore at all times Daniel Liddick was responsible for his own affairs. The Defendant was only given the power to aid Daniel Liddick, which she did. 39. Admitted. 40. Denied, at no time did the Defendant break her fiduciary responsibility to Daniel Liddick. 41. Denied, at no time did the Defendant break her fiduciary responsibility to Daniel Liddick. 42. Denied in that the Defendant was not a guardian, but only a power of attorney, and therefore at all time Daniel Liddick was responsible for his own affairs. The Defendant was only given the power to aid Daniel Liddick, which she did. 43. Admitted. 44. Denied, at no time did the Defendant break her fiduciary responsibility to Daniel Liddick. 45. Denied, at no time did the Defendant break her fiduciary responsibility to Daniel Liddick. 46. Admitted. 47. Admitted. 48. Admitted. 49. Denied, at no time did the Defendant break her fiduciary responsibility to Daniel Liddick. 50. Denied, at no time did the Defendant break her fiduciary responsibility to Daniel Liddick. 51. Denied, at no time did the Defendant break her fiduciary responsibility to Daniel Liddick. 52. Denied, the Defendant has not violated 23 Pa.C.S. Section 4603, in that the section applies to those that can afford to support an indigent person and the Defendant cannot afford to support Daniel Liddick, Daniel Liddick is not indigent, Daniel Liddick has four children who are not named in Plaintiffs Complaint, and the procedure under the forgoing section has not been followed by the Plaintiff. WHEREFORE, the Defendant request that this Court dismiss the Plaintiffs Complaint because at all times the Defendant maintained her fiduciary responsibility to Daniel Liddick and was not the Guardian of the Person or Estate of Daniel Liddick and is therefore not responsible for the amount allegedly due the Plaintiff. Submitted by: Attorney for e Defendant Derek-C,ordier Esquire Sup. Ct. # 4 319 South Front Street Harrisburg, PA 17104-1621 (717) 919-4002 I verify that the statements made in the foregoing Answer to Complaint are true and correct. I understand that false statements herein are made subject to the penalties of 18 Pa.C.S. § 4904, relating to unsworn falsification to authorities. Lorraine Goforth ate (1 a? i? ,._ -n d ---I G) ??;-' > (, 7 Ol -? County of Cumberland, Claremont Nursing and Rehabilitation Center vs Case No. 05-5604 Lorraine Goforth Statement of Intention to Proceed To the Court: Plaintiff Print Name Steven M. Montresor intends to proceed with the above captioned matter. Sign Name Date: 10/28/2008 Attorney for Plaintiff Explanatory Comment The Supreme Court of Pennsylvania has promulgated new Rule of Civil Procedure 230.2 governing the termination of inactive cases and amended Rule of Judicial Administration 1901. Two aspects of the recommendation merit comment. I. Rule ojcivil Procedure New Rule of Civil Procedure 230.2 has been promulgated to govern the termination of inactive cases within the scope of the Pennsylvania Rules of Civil Procedure. The termination of these cases for inactivity was previously governed by Rule of Judicial Administration 1901 and local rules promulgated pursuant to it. New Rule 230.2 is tailored to the needs of civil actions. It provides a complete procedure and a uniform statewide practice, preempting local rules. This rule was promulgated in response to the decision of the Supreme Court in Shop v. Eagle, 551 Pa. 360,710 A.2d 1104 (1998) in which the court held that "prejudice to the defendant as a result of delay in prosecution is required before a case may be dismissed pursuant to local rules implementing Rule of Judicial Administration 1901." Rule of Judicial Administration 1901(b) has been amended to accommodate the new rule of civil procedure. The general policy of the prompt disposition of matters set forth in subdivision (a) of that rule continues to be applicable. II Inactive Cases The purpose of Rule 230.2 is to eliminate inactive cases from the judicial system. The process is initiated by the court. After giving notice of intent to terminate an action for inactivity, the course of the procedure is with the parties. If the parties do not wish to pursue the case, they will take no action and "the Prothonotary shall enter an order as of course terminating the matter with prejudice for failure to prosecute." If a party wishes to pursue the matter, he or she will file a notice of intention to proceed and the action shall continue. a. Where the action has been terminated If the action is terminated when a party believes that it should not have been terminated, that party may proceed under Rule230(d) for relief from the order of termination. An example of such an occurrence might be the termination of a viable action when the aggrieved party did not receive the notice of intent to terminate and thus did not timely file the notice of intention to proceed. The timing of the filing of the petition to reinstate the action is important. If the petition is filed within thirty days of the entry of the order of termination on the docket, subdivision (d)(2) provides that the court must grant the petition and reinstate the action. If the petition is filed later than the thirty-day period, subdivision (d)(3) requires that the plaintiff must make a show in to the court that the petition was promptly filed and that there is a reasonable explanation or legitimate excuse both for the failure to file the notice of intention to proceed prior to the entry of the order of termination on the docket and for the failure to file the petition within the thirty-day period under subdivision (d)(2). B. Where the action has not been terminated An action which has not been terminated but which continues upon the filing of a notice of intention to proceed may have been the subject of inordinate delay. In such an instance, the aggrieved party may pursue the remedy of a common law non pros which exits independently of termination under Rule 230.2. *? v cD dysu ' k co taRe. ? pr +E•